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Could diarrhea and other gastrointestinal issues be the first signs of the novel coronavirus, also known as COVID-19? Yes, at least according to one study published Thursday in The American Journal of Gastroenterology.
The study, conducted by Chinese researchers, looked at data from 204 coronavirus patients in China’s Hubei province, the epicenter of the outbreak. Of the 204 patients, 99 of them -- about 48.5 percent -- presented to the hospital with “with one or more digestive symptoms as their chief complaint,” namely diarrhea, vomiting or abdominal pain, per the study.
“Of these 99 patients, 92 developed respiratory symptoms along with digestive symptoms, and 7 presented with only digestive symptoms in the absence of respiratory symptoms. Among the 105 patients without digestive symptoms, 85 presented only with respiratory symptoms, and 20 neither had respiratory nor digestive symptoms as their chief complaint,” the authors wrote.
Not only could digestive issues be the first sign of illness, but the patients who reported them became more seriously ill than those who did not.
“Moreover, as the severity of the disease increased, digestive symptoms become more pronounced. Patients without digestive symptoms were more likely to be cured and discharged at the time of this study than patients with digestive symptoms,” the authors wrote, noting 60 percent of patients without digestive symptoms subsequently recovered and were discharged, compared to roughly 34 percent of those with digestive symptoms.
The researchers concluded that their findings call for more research that evaluates “the prevalence, incidence, predictors, and outcomes of digestive symptoms in this still-emerging pandemic.”
“In the meantime, clinicians must bear in mind that digestive symptoms, such as diarrhea, may be a presenting feature of COVID-19 that arise before respiratory symptoms, and on rare occasions are the only presenting symptom of COVID-19. Clinicians should raise their index of suspicion when at-risk patients, such as those exposed to COVID-19, present with fever and digestive symptoms, even in the absence of respiratory symptoms,” the study's authors wrote. “This knowledge may help with earlier identification of COVID-19, faster time to treatment, earlier quarantine, and lower exposure to bystanders.”
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The findings come after scientists from the Renmin Hospital of Wuhan University and the Wuhan Institute of Virology of the Chinese Academy of Science in February discovered the novel virus may transmit through the digestive tract, specifically the fecal-oral route, in addition to respiratory droplets.
More specifically, those researchers found “virus genetic material” in stool samples and rectal swabs from some patients.